Healthcare Provider Details

I. General information

NPI: 1992374573
Provider Name (Legal Business Name): LAUREN RILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NW SOUTH OUTER RD STE 200
BLUE SPRINGS MO
64015-3069
US

IV. Provider business mailing address

9126 N HOLLY ST
KANSAS CITY MO
64155-2855
US

V. Phone/Fax

Practice location:
  • Phone: 888-256-3814
  • Fax: 888-256-9054
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number2021017259
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: